Provider Demographics
NPI:1558355339
Name:ONTARIO CLINIC PHARMACY
Entity Type:Organization
Organization Name:ONTARIO CLINIC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-881-1213
Mailing Address - Street 1:293 SW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-4530
Mailing Address - Country:US
Mailing Address - Phone:541-881-1213
Mailing Address - Fax:
Practice Address - Street 1:293 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4530
Practice Address - Country:US
Practice Address - Phone:541-881-1213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP-0001468-CS183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR292942Medicaid
ID0033549Medicaid
OR134325Medicaid
ID0033548Medicaid
3812244OtherNABP#
3812244OtherNABP#
OR292942Medicaid
0243160002Medicare NSC